How to Assess Suicide Risk

Family, friends, co-workers, and other peers can play a valuable role in reducing a man’s risk for suicide.^[1-3]

When supporting a guy who is experiencing mental health difficulties, understanding the basics of assessing suicide risk could help save his life.

A Guide to Recognizing Suicide Risk Factors

Assessing suicide risk is not an objective process (in other words, there is not a specific “technique” or standardized protocol to risk assessment) or an “exact science” (meaning that suicide risk assessment is not 100% accurate). Nevertheless, awareness of what can contribute to heightening someone’s risk for suicide gives us an opportunity to intervene before it may be too late.

Keep in mind that many of the factors that can contribute to suicide risk can fluctuate over time and are different for every guy, so accurately identifying a guy’s risk of suicide is not always straightforward.^[4-6]

1. Personal History

These generally include his personal background, health, family history, social relationships, etc. that may make him more vulnerable to thoughts of suicide and/or acting on such thoughts. Specific factors include:

• Previous suicide attempt
• Having visited the ER within the past month
• Family history of suicide 
• Social isolation or living alone
• History of personal trauma (physical, sexual, emotional)
• An unwillingness, aversion to, or inability to get medical/professional support
• Unemployment, job loss, or financial issues
• Having experienced a failed romantic relationship in the past year
• Homelessness
• Chronic physical illness/chronic pain
• Having recently lost a loved one

2. Behaviours

Certain behaviours may put a guy at an increased risk for suicide. Keep an eye out for:

• Sleep problems (trouble sleeping or sleeping too much)
• Despondency 
• Impulsivity or recklessness
• Social withdrawal
• Aggression or violent behaviours toward others or himself
• Anxiousness and/or irritability
• Taking less care of his appearance
• Struggling or failing to keep up with life responsibilities (work, school, family commitments, etc.)
• Disinterest in hobbies, activities, and/or other things that he previously found joy and pleasure in
• Uncharacteristic substance use, or misuse (alcohol, nicotine, marijuana, opioids, psychedelics, etc.)

3. Desire

While some men may feel comfortable being open about their feelings, including feeling suicidal, others may only provide subtle hints. Indeed, it’s fairly common for men to avoid expressing suicidal ideation in a clear and direct way.

Because a desire for suicide or an escape from life is not always obviously expressed, we need to be aware of the things he says, writes about, posts to social media, etc. in order to gauge his desire for suicide.

His desire can be actively or passively expressed ^[4] and may sound like the following:

• Active
  • “I just want to die.”
  • “I want to kill myself.”
  • “I’m gonna commit suicide.”
  • “If things don’t change, I’ll end my life.” 
• Passive
  • “I wish I’d just fall asleep and not wake up sometimes.”
  • “My family would have a better life if I wasn’t alive.”
  • “I’m so tired, I just want to be gone.” 
  • “Everything sucks, I want to escape from it all.”
  • “If I died, they’d be better off.”
  • “Nothing good ever happens to me. Life’s not worth it.”

Whether his desire for suicide is expressed more actively or passively, such comments signal that he’s feeling hopeless or like a burden, and need to be taken seriously. 

4. Intent

Many men experience challenging periods in their lives where they may have passive or active suicidal thoughts. However, once they begin to display intentions or make plans to act on these thoughts, it becomes crucial to intervene to ensure their safety.^[7]

If a guy is intending to act on his suicidal thoughts, some things you may notice him doing include:

• Cleaning up or organizing on an unusually large scale (e.g., sorting out all his belongings, cleaning out his apartment)
• Selling or getting rid of his belongings
• Making a will or updating an existing will
• Asking you to take care of his family, pets, kids, house, etc., if “something” ever happens to him
• Visiting his loved ones unexpectedly

Additionally, a key aspect of a strong intent is him having thought out or prepared a suicide plan. While a guy may not mention his plan to avoid worrying you, if he has voiced suicidal thoughts, it’s crucial that you ask him directly if he has a suicide plan in place. 

You may ask him about the following: 

• Has he thought about a specific way to die by suicide?
• Does he already have or know how to access lethal means?
• Has he thought about a specific date, time, and/or location to die by suicide?
• Has he rehearsed or gone through the motions of his plan like loading/pointing his gun, tying a noose, pouring pills into his hand?
• Has he visited the location, if not planning to do it at home (e.g., spending more time around a bridge, building, body of water, overpass, train track)? 

The more concrete and detailed his plan is, the higher his risk is for acting on the plan. 

For guidance on how to have a conversation about suicide, see the Start a Conversation portion of our Gauging and Responding to Risk page.

5. Means

This refers to whether or not a man physically has access to or can easily gain access to a method for dying by suicide and, if he has a suicide plan, the specific means that he’s mentioned. Things to keep an eye out for:

• He currently has firearms, medications, chemicals, rope, etc.
• He’s planning on purchasing/accessing a gun, rope, pills, chemicals, etc.
• He knows how, where, and/or from whom he can purchase different means
• He knows how to access and/or how to get to his means (e.g., train tracks, bridge, body of water)

If you’re worried about a guy and he currently has a means for suicide in his home, express your concern to him and ask if you can remove or prevent access to these items by offering to keep them at your place, or getting him to put them somewhere that makes it harder for him to access them (e.g., a safe or a roommate’s room).

By removing, reducing, preventing, or impeding his access to lethal means, we’re creating an inconvenient roadblock in his plan that may reduce his desire or capability to follow through.

Protective Factors

The factors described above can contribute to an increase in someone’s risk for suicide.

However, there are also factors that can help reduce risk. Protective factors are aspects of a man’s life that can reduce his risk for suicide.^[5-6] Such factors include:

• Having long-term life goals that he finds inspiring/motivating 
• Making future plans (e.g., booking a vacation, planning for an event) 
• Having deeply held religious or spiritual beliefs
• Having a job he enjoys, values, or is dedicated to
• Financial stability
• Having a good social network that he is well-integrated with 
• Having a good relationship with his family
• Being in a positive romantic relationship
• Being in a position of caretaking (e.g., having children, pets)
• Taking care of himself regularly (e.g., he’s physically active, eats well, cares for his appearance)
• Having a good relationship with a health professional (e.g., therapist or family doctor)
• Can easily access/is willing to access services for mental health 
• Possessing good conflict resolution and problem-solving skills

Protective factors often serve as reasons for living and by recognizing these, we can remind him of his strengths, admirable qualities, and valuable aspects of his life while empathizing with his hardships and supporting him through those hardships.

Generally speaking, the greater the number of risk factors the person has, and the fewer protective factors he has, the higher his risk is for suicide.

Note that suicide risk can rise and fall, so check in on the guy you’re concerned about and keep an eye out for any changes to the factors we’ve described above.

Remember, though, that just because a guy is low risk doesn’t mean he’s at no risk, so we still need to offer support as best as we can.

On the other end of the spectrum, just because a guy may currently be high risk doesn’t mean he’ll always be high risk. The danger for suicide often follows a rising then subsiding pattern; it’s important that we support him through the worst of these times.

By knowing which factors in his life may be affecting him the most, we can help him come up with risk-specific coping skills, create a plan to tackle the specific areas in his life, and help him get appropriate professional support.^[8-10]

Next Step:

Note: Most importantly, when supporting a man who is struggling with depression/suicidality, remember to also prioritize your own wellbeing. Taking care of your own mental health is key to being an impactful supporter in a manageable way.

References:

1. Goodman, M.S., & Peters, J. J. (2021). SAFER: A Brief Intervention Involving Family Members in Suicide Safety Planning (SAFER) [Government Research Study no. NCT03034863]. Veterans Affairs Medical Center. VA Office of Research and Development. https://beta.clinicaltrials.gov/study/NCT03034863?tab=results#publications 
2. Bowersox, N. W., Jagusch, J., Garlick, J., Chen, J. I., & Pfeiffer, P. N. (2021). Peer-based interventions targeting suicide prevention: A scoping review. American Journal of Community Psychology, 68(1-2), 232–248. https://doi.org/10.1002/ajcp.12510 
3. Mental Health and Addictions Program. (2021). Guide for People and Families Struggling with Suicide. Niagara Health. https://www.niagarahealth.on.ca/files/GuideforPeopleandFamiliesStrugglingwithSuicideAugust2021Final.pdf
4. Schreiber, J., & Culpepper, L. (Updated: 2022). Suicidal ideation and behavior in adults. UpToDate. https://www.uptodate.com/contents/suicidal-ideation-and-behavior-in-adults
5. O’Rourke, M. C., Jamil, R. T., & Siddiqui, W. (2023). Suicide Screening and Prevention. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531453/
6. Substance Abuse and Mental Health Services Administration. (2021). Helping Your Loved One Who is Suicidal: A Guide for Family and Friends [Publication No. PEP20-01-03-001]. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-01-03-001.pdf
7. Simon, R. I. (2012). Suicide rehearsals: a high-risk psychiatric emergency; patients who rehearse a suicide provide opportunities for clinical interventions. Current Psychiatry, 11(7), 28-32. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/1107CP_Simon.pdf
8. Ryan, E. P., & Oquendo, M. A. (2020). Suicide Risk Assessment and Prevention: Challenges and Opportunities. Focus (American Psychiatric Publishing), 18(2), 88–99. https://doi.org/10.1176/appi.focus.20200011
9. Alberta Health Services. (2022). Suicidal Thoughts in a Family Member: Care Instructions. Alberta Health Services. Government of Alberta. https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?HwId=ut3131
10.  CAMH. (n.d.). When a Family Member Is Thinking About Suicide. The Centre for Addiction and Mental Health. https://www.camh.ca/en/health-info/guides-and-publications/when-a-family-member-is-suicidal